Reporting on Disaster-Related Deaths

Beginning of Survey

Thank you for participating in this needs assessment to help inform disaster-related mortality death certification in your region. Your participation is extremely important and completely voluntary. All responses will be kept confidential and private. This Centers for Disease Control and Prevention (CDC) funded work is being over seen by Montgomery County Coroner's Office and the National Network of Public Health Institutes (NNPHI).

The purpose of this assessment is to learn about your awareness/knowledge as it relates to reporting on disaster-related deaths. At the completion of this survey, you will be provided a link to begin the Death Certificate Training.

Question Title

* 1. Which of the following best describes your work setting?

Hospital

Medical Practice

Funeral Home

Local Health Department: Forensic Center/Coroner/Medical Examiner's Office

State Health Department: Forensic Center/Coroner/Medical Examiner's Office

Other agency/Independent Forensic Center/Coroner/Medical Examiner's Office

Local Health Department: Vital Records or Statistics Office

State Health Department: Vital Records or Statistics Office

Other (please specify)

Question Title

* 2. Which of the following best describes your job title? (If you are both a physician and a medical examiner, select ME. If you are both a physician and a coroner, select coroner.)

Nurse Practitioner

Medical Examiner

Coroner

Funeral Director

Physician

Other (please specify)

Question Title

* 3. How long have you been in this role?

0 to <5 years

5 to <10 years

10 to <15 years

15 to <20 years

20+ years

Question Title

* 4. How long do you anticipate staying in this role?

0 to <5 years

5 to <10 years

10 to <15 years

15 to <20 years

20+ years

Question Title

* 5. When was the last time you participated in a death certification training?

Less than 1 year ago

Between 1-5 years ago

More than 5 years ago

I have not participated in death certification training